How long should dual antiplatelet therapy be continued after PCI?

  • Yin SH & al.
  • BMJ
  • 28 Jun 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Long-term dual anti-platelet therapy (DAPT) was associated with a higher risk for major bleeding and mortality, and standard-term DAPT was associated with increased risk for any bleeding compared with short-term DAPT (clopidogrel) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES).
  • Standard-term DAPT showed similar safety and efficacy compared with short-term DAPT.

Why this matters

  • The recommendation for ≥12 months of DAPT after PCI with DES has received scrutiny by several randomised controlled trials, which proved nonsuperiority vs 3-6 months of DAPT.
  • Findings suggest it might be reasonable to apply long-term DAPT to a narrower spectrum of patients

Study design

  • 17 randomised controlled trials (RCTs; n=46,864) met eligibility criteria after a search across electronic database.
  • Efficacy outcomes: all-cause mortality, cardiac and non-cardiac mortality, myocardial infarction (MI), stroke, stent thrombosis and adverse events.
  • Safety outcomes: major and any bleeding.
  • Funding: Major Science and Technology Project of Hunan Province; others.

Key results

  • Long- vs short-term DAPT was associated with increased risk for:
    • all-cause mortality (OR, 1.18; 95% CI, 0.93-1.49),
    • cardiac death (OR, 1.28; 95% CI, 0.88-1.86),
    • non-cardiac death (OR, 1.63; 95% CI, 1.03-2.59),
    • major bleeding (OR, 1.78; 95% CI, 1.27-2.49) and
    • any bleeding (OR, 2.13; 95% CI, 1.46-3.10).
  • Standard- vs short-term DAPT was associated with a higher risk for any bleeding (OR, 1.39; 95% CI, 1.01-1.92).
  • Long- and standard- vs short-term DAPT did not differ in MI, stroke, stent thrombosis and adverse events.
  • In the subgroup analysis, among patients implanted with newer-generation DES, long- vs short-term DAPT showed a higher risk for:
    • all-cause mortality (OR, 1.99; 95% CI, 1.04-3.81),
    • major bleeding (OR, 1.88; 95% CI, 1.03-3.45) and
    • any bleeding (OR, 1.79; 95% CI, 1.28-2.50). 

Limitations

  • Duration of DAPT was evaluated based on clopidogrel only.
  • Analyses of outcomes were performed from different trials with pooled definitions.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit